One-off low-dose CT lung cancer screening in China: an appropriate strategy?

Abstract

Lung cancer is devastating, with a 5-year survival rate of about 10%. High smoking prevalence in the past means that millions of people are at high risk of developing lung cancer. Two large-scale randomised controlled trials (RCTs) have shown that screening with high-quality, low-dose CT (LDCT) can detect lung cancer substantially earlier than when being diagnosed symptomatically, and thereby reduce mortality from the disease by 8–24% (point estimates of trials) in men and by 26–61% in women. 1 de Koning HJ van der Aalst CM de Jong PA et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med. 2020; 382: 503-513 Crossref PubMed Scopus (957) Google Scholar , 2 Aberle DR Adams AM Berg CD et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365: 395-409 Crossref PubMed Scopus (6627) Google Scholar The LUSI RCT recently confirmed that repeated LDCT is associated with a reduction in lung cancer mortality in women. 3 Becker N Motsch E Trotter A et al. Lung cancer mortality reduction by LDCT screening—results from the randomized German LUSI trial. Int J Cancer. 2020; 146: 1503-1513 Crossref PubMed Scopus (173) Google Scholar The evidence from these trials has led the way to careful but slow progress in implementation studies throughout Europe, 4 Rzyman W Szurowska E Adamek M Implementation of lung cancer screening at the national level: Polish example. Transl Lung Cancer Res. 2019; 8: S95-105 Crossref PubMed Scopus (20) Google Scholar , 5 Balata H Ruparel M O'Dowd E et al. Analysis of the baseline performance of five UK lung cancer screening programmes. Lung Cancer. 2021; 161: 136-140 Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar , 6 Van der Aalst C Oudkerk M Haaf KT et al. Towards personalized lung cancer CT screening in Europe. Eur Respir J. 2020; 564171 Google Scholar insurance coverage in the USA (by the B recommendations of the US Preventive Services Task Force), 7 Meza R Jeon J Toumazis I et al. Evaluation of the benefits and harms of lung cancer screening with low-dose computed tomography: modeling study for the US Preventive Services Task Force. JAMA. 2021; 325: 988-997 Crossref PubMed Scopus (70) Google Scholar and preliminary recommendations in Australia and Europe to consider national lung cancer screening programmes. The common aim of such programmes is to invite current and former smokers in the age range 50–80 years with a specific expected minimum risk (eg, current or former smoking history of 20 pack-years, or a minimum PLCOm2012 risk score of around 2–3% for developing lung cancer in the next 6 years, with no difference between the sexes) for LDCT screening. But can the results of trials that were done in high-income countries with largely White populations simply be applied to other ethnic groups, such as those of Chinese and Asian descent, in which other risk profiles seem to be important too? In China, especially in women, the proportion of lung cancer cases attributable to tobacco use is only about 18%. 8 Li N Tan F Chen W et al. One-off low-dose CT for lung cancer screening in China: a multicentre, population-based, prospective cohort study. Lancet Respir Med. 2022; (published online March 8.)https://doi.org/10.1016/S2213-2600(21)00560-9 Summary Full Text Full Text PDF Scopus (9) Google Scholar Notably, more than 700 000 lung cancer deaths were estimated in China in 2020, which is 40% of the total lung cancer deaths worldwide. 9 Ferlay JEM Lam F Colombet M et al. Global Cancer Observatory: cancer today. International Agency for Research on Cancer, Lyon, France2022https://gco.iarc.fr/today/online-analysis-table?v=2020&mode=cancer&mode_population=countries&population=900&populations=935_908_900_160&key=asr&sex=0&cancer=39&type=1&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&group_cancer=1&include_nmsc=0&include_nmsc_other=1#collapse-group-0-3Date accessed: January 18, 2022 Google Scholar One-off low-dose CT for lung cancer screening in China: a multicentre, population-based, prospective cohort studyOne-off LDCT screening was associated with significantly lower lung cancer mortality and all-cause mortality in a large population in China. Our results point to the promise of one-off LDCT screening in countries with limited medical resources. Further studies are needed to explore interactions by subgroup—including sex, age, smoking status, and economic status—to develop population-specific screening strategies. Full-Text PDF